Organization
FUNCTIONAL ASSESTMENT CENTERS OF OKLAHOMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL WALLACE P.T. (DIRECTOR)
(405) 879-6766
Entity
Organization
Contact information
Practice address
409 E. CALIFORNIA AVE., OKLAHOMA CITY, OK 73104
(405) 879-6766
(405) 879-3493
Mailing address
409 E. CALIFORNIA AVE., OKLAHOMA CITY, OK 73104
(405) 879-6766
(405) 879-3493
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT2855
OK
Other
Enumeration date
11/20/2006
Last updated
08/22/2020
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